Bronchoalveolar lavage fluid in a patient with hemoptysis

Bronchoalveolar lavage fluid recovered after the first aliquot of saline infused shows bloody return. The bubbly, white material on the top of the syringe is from surfactant washed out of the alveoli. The red, bloody return is consistent with alveolar hemorrhage. The fluid should be sent for microscopy to evaluate for hemosiderin-laden macrophages, which if present, suggest that the bleeding is subacute or chronic, rather than acute.